Citation Nr: 21062695 Decision Date: 10/08/21 Archive Date: 10/08/21 DOCKET NO. 16-37 260 DATE: October 8, 2021 REMANDED Entitlement to service connection for a left leg disorder is remanded. Entitlement to service connection for a left knee disorder is remanded. Entitlement to service connection for a sleep disorder is remanded. Entitlement to service connection for residuals of cold weather injuries is remanded. Entitlement to service connection for a low back disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1994 to May 1998. As requested by the Veteran on his July 2016 VA Form 9, a hearing was scheduled in May 2019, for which the Veteran did not report. However, as it was unclear whether the Veteran received notice of his scheduled hearing, the Board scheduled him for a new hearing in July 2019. Again, the Veteran failed to report and, again, the record is unclear as to whether the Veteran was properly notified. Accordingly, in July 2021, the Veteran was afforded one final chance to be rescheduled for a hearing, but he did not respond to the notification letter. Therefore, the Board will proceed as if the hearing request has been withdrawn. 38 C.F.R. § 20.603 (d) (2020). 1. Left leg disorder The Veteran is seeking entitlement to service connection for a left leg disorder, claimed as complex regional pain syndrome, that he believes is due to his military service. Specifically, he claims that due to a fracture to the left leg incurred during a nighttime parachute jump in January 1996, he has suffered from chronic pain and other residuals, such as limping. See April 2012 Lay Statement; see also July 2016 VA Form 9. The Veteran's service treatment records show that he fractured his left leg in service in January 1996. His military personnel records also show he is in receipt of a Parachutist Badge. See DD Form 214. A December 2012 VA Examination report noted a history of complex regional pain syndrome, with no evidence on examination. As to the etiology of this disorder, the examiner concluded that it was less likely than not that the current disorder was incurred during service as the Veteran's current disorder was not the same as the one for which treatment was provided in service. However, the examiner did not provide an opinion as to whether the Veteran suffers from any residuals of the in-service treatment, or if the current disorder may be a progression of the in-service injury. Therefore, the Board finds this opinion is inadequate and a remand is required. See Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007). 2. Left knee disorder The Veteran is seeking entitlement to service connection for a left knee disorder that he believes is due to his military service. Specifically, he claims that he also injured his left knee during a nighttime parachute jump in January 1996, and during repeated jumps thereafter. See July 2016 VA Form 9. The Veteran's miliary personnel records show he is in receipt of a Parachutist Badge. See DD Form 214. Further, a January 1997 service treatment record notes the Veteran's reports of left knee pain, beginning in November 1996. A December 2012 VA Examination report noted a history of retropatellar pain syndrome, resolved. As to the etiology of this disorder, the examiner concluded it was less likely than not that the current disorder was incurred during service as the Veteran's current disorder was not the same as the one for which treatment was provided in service. However, the examiner did not provide any further rationale as to the etiology of a currently diagnosed left knee disorder. Moreover, an opinion as to whether the Veteran suffers from any residuals pertaining to the knee due to the in-service fracture, or if the current disorder may be a progression of the in-service injury was not provided. The Board finds this opinion is inadequate and a remand is required. See Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007). 3. Sleep disorder The Veteran is seeking entitlement to service connection for a sleep disorder, claimed as insomnia, that he believes is due to his military service. An April 1997 service treatment record indicates the Veteran reported having trouble sleeping. The record reflects that the Veteran does have a diagnosis of insomnia, which has been confirmed as a symptom of his now service-connected posttraumatic stress disorder (PTSD). However, as it is unclear whether the Veteran may have a separately diagnosed sleep disorder (other than insomnia) that is otherwise attributable to his military service. Therefore a remand for a VA examination is required. 4. Residuals of cold weather injuries The Veteran is seeking entitlement to service connection for residuals of cold weather injuries to the hands and feet, claimed as hypothermia, that he believes is due to his military service. Specifically, he claims that he suffered from cold weather injuries during his time in Ranger School and has experienced residuals affecting his hands and feet since that time. See April 2012 Lay Statement. A December 2012 VA examination noted a diagnosis of hypothermia, with color changes and cold sensitivity affecting the upper and lower extremities. However, in providing an etiological opinion, the VA examiner stated that there was no evidence of residuals of cold weather injury, to include hypothermia. The Board finds the December 2012 VA examination report is inadequate for rating purposes as the findings of the VA examiner are internally inconsistent. Therefore a remand for a VA examination is required. 5. Low back disorder The Veteran is seeking entitlement to service connection for a low back disorder that he believes is due to his military service. Specifically, he claims that also injured his low back during a nighttime parachute jump in January 1996, and during repeated jumps thereafter. See July 2016 VA Form 9. The Veteran's miliary personnel records show he is in receipt of a Parachutist Badge. See DD Form 214. A December 2012 VA Examination noted a diagnosis of mechanical lumbar strain, resolved. As to the etiology of this disorder, the examiner concluded it was less likely than not that the current disorder was incurred during service as the Veteran's service treatment records do not show reports of back pain following the in-service parachute fall. The Board finds this opinion is inadequate as the examiner relied solely on the absence of in-service treatment in rendering the unfavorable opinion. As such, a remand is required. See Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007). The matters are REMANDED for the following action: 1. Obtain and associate with the claims file any outstanding VA or private treatment records, inclusive of all VA medical centers, dating from June 2020 to the present. 2. Schedule the Veteran for VA examinations to determine the nature and etiology of the claimed disorders addressed below. A complete rationale for all opinions offered must be provided. The respective examiners are asked to provide an opinion on the following, with a full rationale: (a.) Left leg disorder (claimed as complex regional pain syndrome): 1. Identify any and all currently diagnosed left leg disorders, to include complex regional pain syndrome. 2. If no clinical diagnosis of the left leg is made, the examiner must ascertain whether the Veteran's claimed disorder, to include pain, constitutes a functional impairment of earning capacity. If the Veteran's pain does not reach this threshold, and thus should not be considered a disability, the examiner should so clarify. 3. For each disorder, the examiner is asked to determine whether it is at least as likely as not (a 50 percent or greater probability) related to the Veteran's active service, to include whether the disorder is the type that would be expected to occur following repeated parachute jumps in-service or after a fracture to the left leg. (b.) Left knee disorder: 1. Identify any and all currently diagnosed left knee disorders. 2. If no clinical diagnosis of the left knee is made, the examiner must ascertain whether the Veteran's claimed disorder, to include pain, constitutes a functional impairment of earning capacity. If the Veteran's pain does not reach this threshold, and thus should not be considered a disability, the examiner should so clarify. 3. For each disorder, the examiner is asked to determine whether it is at least as likely as not (a 50 percent or greater probability) related to the Veteran's active service, to include whether the disorder is the type that would be expected to occur following repeated parachute jumps in-service or after a fracture to the left leg. (c.) Sleep disorder: 1. Identify any and all currently diagnosed sleep disorders, other than insomnia which has been determined to be a symptom of his service-connected PTSD. 2. For each disorder, the examiner is asked to determine whether it is at least as likely as not (a 50 percent or greater probability) related to the Veteran's active service. (d.) Residuals of cold injuries: 1. Identify any and all currently diagnosed residuals of cold injuries, to include hypothermia. 2. If no clinical diagnosis is made, the examiner must ascertain whether the Veteran's claimed disorder, to include pain of the hands and feet, constitutes a functional impairment of earning capacity. If the Veteran's pain does not reach this threshold, and thus should not be considered a disability, the examiner should so clarify. 3. For each disorder, the examiner is asked to determine whether it is at least as likely as not (a 50 percent or greater probability) related to the Veteran's active service, to include whether the disorder is the type that would be expected to occur following his Ranger School training. (e.) Low back disorder: 1. Identify any and all currently diagnosed low back disorders. 2. If no clinical diagnosis of the low back is made, the examiner must ascertain whether the Veteran's claimed disorder, to include pain, constitutes a functional impairment of earning capacity. If the Veteran's pain does not reach this threshold, and thus should not be considered a disability, the examiner should so clarify. 3. For each disorder, the examiner is asked to determine whether it is at least as likely as not (a 50 percent or greater probability) related to the Veteran's active service, to include whether the disorder is the type that would be expected to occur following repeated parachute jumps in-service or after a fracture to the left leg. The term "at least as likely as not" does not mean "within the realm of medical possibility." Rather, it means that the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of the conclusion (e.g., etiology) as it is to find against the conclusion. The examiners are advised that the Veteran is competent to report his symptoms and history, and such reports MUST be acknowledged and considered in formulating any opinion. THE MEDICAL TREATISE LITERATURE AND INFORMATION RECEIVED REGARDING RANGER SCHOOL TRAINING PROVIDED BY THE VETERAN AND HIS REPRESENTATIVE IN RENDERING THE ABOVE REQUESTED OPINIONS SHOULD ALSO BE CONSIDERED. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 3. The AOJ must review the claims file and ensure that the foregoing development action has been completed in full. If any development is incomplete, appropriate corrective action must be implemented. If any report does not include adequate responses to the specific opinions requested, it must be returned to the providing examiner for corrective action. YVETTE R. WHITE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Berry, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.